Using Electronic Health Records to Improve Communication With Patients

One thing is certain: the [electronic health record] in the examination room is here to stay.

—Thomas W. LeBlanc, MD, and colleagues

Clinicians may argue that electronic health records (EHRs) interfere with the patient-physician relationship, and patients may complain about “distracted doctors,” too busy with computer screens to make eye contact, but according to Thomas W. LeBlanc, MD, MA, of Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, and colleagues, “one thing is certain: the EHR in the examination room is here to stay.” Having conceded that point, the physician authors of an article published online by the Journal of Oncology Practice, noted that their goal is “to provide evidence-based suggestions to help busy clinicians integrate the electronic health record into their workflow in a way that is constructive for communication and the patient-clinician relationship.”1

‘Six Ingredients for Success’

In comparison with other health-care settings, “communication in oncology is often even more high-stakes, involving complex dilemmas, emotional content, clinical uncertainty, and life-limiting illness,” the researchers wrote. They offered “six ingredients for success,” which were “extrapolated from the substantial evidence on high-quality patient-centered communication, to promote the successful integration of the EHR into the oncology clinic.”

1. “Position yourself for dual access, to the EHR and to the patient.” The computer screen shouldn’t be a barrier between the clinician and patient, but should serve as a bridge or a “conduit for information flow, and an opportunity for more active patient participation.” Proper positioning allows the patient to view the screen along with the clinician.

2. “Ask permission or acknowledge that you will use the EHR.” Explain that the computer is there to accurately document the patient’s visit and that you will be entering information while talking to the patient. “Few, if any, patients will decline, but asking their permission helps to position the computer more positively as an integral component of their care,” the researchers wrote. Avoid making apologies for the computer or the EHR; apologies are generally counterproductive.

3. “Use the EHR as a teaching tool.” Using the computer to show trends in laboratory results or radiographic images “can be a powerful way to integrate the EHR into patient care,” the authors asserted.

4. “Preserve nonverbal contact with the patient.” Make periodic eye contact with the patient and stay alert to the patient’s nonverbal cues.

5. “Organize what you want to accomplish before the visit.” This can help you “use the computer in a less disruptive manner, can save time, and may even improve patient satisfaction with a visit,” the researchers stated.

6. “Demonstrate Internet resources that might contribute to patient activation.” Encourage patients to use Internet resources to fact check on their own and be prepared to show patients useful online resources.

“Clinicians must be attuned to the fact that the computer will amplify pre-existing positive and negative communication behaviors; thus, conscious attention to communication strategies around the computer is important,” the authors concluded.

Use of Patient Portals Increasing

Cancer patients, particularly younger patients, are increasingly using Web-based of electronic portals to access their personal health records, according to retrospective analysis of enrollment and use of the MyChart portal among patients seen at The University of Texas Southwestern Medical Center. This study by David E. Gerber, MD, of the Harold C. Simmons Cancer Center at UT Southwestern, and colleagues was also published online by the Journal of Oncology Practice.2 The investigators looked at use of the portal by 6,495 patients between 2007 and 2012.

According to the investigators, “it appears that portal use by patients with cancer clearly exceeds that reported in other populations.” In addition, over the 6-year period of the analysis, patient enrollment increased fivefold, and total log-ins increased more than 10-fold.

The portal was most commonly used to view test results, accounting for 37% of all portal actions. “The interpretation of such data by individuals without formal medical training outside the context of a health care encounter raises a number of questions,” the authors acknowledged. These concerns include distress and anxiety about the clinical significance of test results. Although the portal includes an electronic health reference library to help patients interpret data, “it was used rarely by patients in our study, accounting for only 0.5% of MyChart actions,” the researchers ­reported.

Other common uses of the portal include viewing and responding to clinic messages (29%), and sending medical advice requests (6.4%), which allows patients to send messages directly to providers and clinic staff. More than 30% of these requests were sent during nonclinic hours, and the investigators voiced concern about delays in urgent medical attention if time-sensitive messages are not seen promptly by the medical team. Although the portal instructions warn patients not to use the medical advice function for urgent messages, there is “a growing societal expectation that text messaging provides real-time communication,” and patients may rely on the portal rather than call the medical center for services after normal business hours. ■

Disclosure: For full disclosures of the study authors, visit jop.ascopubs.org.